Hi,

Many years ago, I got diagnosed with spinal stenosis, mainly at L4. The symptoms I had at that time was mostly that if I stood or walked for any period of time, both of my legs would start going numb and hurt, to the point that it was like I couldn't feel them anymore.

I eventually had a minimally-invasive laminectomy at L4, in 2010, and the results were tremendous. That whole leg numbness was immediately gone.

However, during recovery from that 1st back surgery, I noticed that I had numbness and tightness in both feet and ankles, and on the outside of both calves (I remember sitting during recovery and flexing my ankles and going "huh?", when I first noticed this).

I don't remember if it was also at that time, but currently, I also get intermittent "burning" sensation in the same areas (both feet/ankles/outside of calves).

This numbness/tightness and burning is worse on my right side than on the left side.

I had a 2nd spine surgery, earlier this year, by the same neurosurgeon, for a "re-exploration of L4". He said that he removed some small cysts and bone spurs, but didn't find anything else. I saw the same neurosurgeon after getting a new MRI, and he said that everything looked ok.

So, I subsequently saw a neurologist, who did a bunch of blood tests (lyme disease, lupus, vitamin B, D, etc.) and said they all were ok except some vitamin D deficiency, so I've been taking once a week 50K vitamin D capsules. He also did an EMG, and diagnosed "idiopathic" peripheral neuropathy.

I had asked him if he could tell if it might be being caused by something going on in my spine, but he said that he could only do the EMG from the knee down because it was too soon after my most recent back surgery. The reason that I asked this is that, to me, it feels like the numbness/tightness and burning get worse after I've sat for awhile.

Aside from this, I also got diagnosed with ostheoarthritis in my right hip (bone-on-bone), and so I just had a hip replacement done on my right hip (currently still recovering from that).

I recently ran across some info that indicated that this kind of burning might be caused by undiagnosed diabetes, so I just had a 2 hour oral glucose tolerance test done this week, and everything was ok (92@fasting, 91@2 hours).

As I mentioned above, I am still having this numbness/tightness and intermittent burning, and am not sure where to go next.

I understand "idiopathic", but I would really like to be able to find out if it's being cause by a back problem or not.

During the period that I was seeing the doctor that did my recent hip replacement, I also saw one of the doctors in that same practice that specialized in spine issues, and he looked at my post-spinal surgery MRIs and basically ridiculed "minimally-invasive surgery" and said that what he thought that I needed to do was a full laminectomy on both L4 and L5 and a fusion, so I'm stuck between 2 different opinions: the neurosurgeon who did my 2 surgeries says no back problems and the other orthopedic surgeon says I need full laminectomy to eliminate the neuropathy.

I'm kind of inclined to go to either the same neurologist that I've been seeing, or maybe another one, and try to get a new EMG or NCV. The question is, having had a hip replacement 2 months ago, if I did that, would they be able to answer the question of whether or not this numbness/tightness and burning is being caused by back problems?

Thanks, and apologies for the long post.

Jim

Welcome to NeuroTalk:

I am going to suggest you get your test results for B12 in numbers. "normal" is not normal today, because the lab ranges have not been updated to the new information about this vitamin.

Hence you may be really low and not know it.

The B12 thread:
http://neurotalk.psychcentral.com/thread85103.html
The 2003 link to American Association of Family Physicians has the guidelines for doctors now explained at a minimum of 400 US units.

All that surgical trauma of the spine certainly has a suspicious air as far as PN goes.

But also you know, drugs, and lifestyle also factor into PN quite a bit. So what drugs have you taken and are taking now?
Also vaccine history.

mrsD,

After the 1st spine surgery (2 years ago), I was given Hydrocodone and Lyrica during the recovery. I took the Lyrica for maybe 2-3 weeks, then stopped that, and only took the hydrocodone for awhile (maybe 1.5 months) after that. Again, that was 2 years ago, just after the 1st surgery.

More recently, after I saw the neurologist, he prescribed Horizant for the numbness/burning, which is a newer/branded version of neurotonin. I took that for over a month, but it didn't relieve the symptoms at all.

After that, I wasn't taking anything for a couple of months, until just before my recent hip replacement surgery. When I first got diagnosed with the hip problem, the doctor prescribed meloxicam, for the hip pain, which I took for about 3 weeks, and stopped that a week before the surgery (in early August).

After the hip replacement, I've been taking hydrocodone (7.5/325), mainly for pain, for about 8 weeks now. The most I've been taking that is 1x4times a day, but for the last 2 weeks, I've been trying to wean myself off of it, and am now down to taking 2 per day.

In the last 2 weeks, I've also been taking 2 benadryls at night, to help get some sleep (apparently, this is a common problem with hip replacement recoveries).

I'll try to get the B12 numbers from the neurologist's tests and post back.

I'm still interested in if getting another EMG might be able to pinpoint whether the leg/feet/ankle numbness/burning is from a spine problem or not? Also, since I'm now only about 2 months post the hip surgery, and now have a metal prosthetic, would that cause any problems with getting an EMG or nerve conduction test?

Thanks,
Jim

P.S. I forgot to mention, besides the hydrocodone and benadryl I'm currently taking, since after the hip surgery, I've been taking a number of different supplements (wife's idea ).

I'll need to find out what exactly, but it's like glucosamine (e.g., move free from costco) and some other stuff.

Also forgot to mention that in the period before the hip surgery in August, I was having acupuncture, 2-3 times a week, for about 10 weeks, with no improvement re. the leg/feet/ankle numbness/burning. That Chinese doctor also had me taking some herbal medicine for inflammation (huo luo xiao lin dan/HLXL).

Jim

The drugs I am looking for are not related to this problem.

They are mostly statins for cholesterol and certain antibiotics.
These can damage nerves.

Here is post about drug damage.
http://neurotalk.psychcentral.com/thread122889.html

There have been posters here who report PN after joint replacements. It might be a trigger, from a reaction to the
metal used.
http://bonesmart.org/forum/threads/m...acement.13261/

Hi,

I haven't really taken any statins as far as I'm aware (haven't had problem with cholestorol). I've taken antibiotics occasionally, e.g., maybe for a flu, but haven't for a number of years, I think.

Re. your last paragraph, as I mentioned earlier, this numbness, etc. was noticed a couple of years ago, whereas my hip replacement was ~2 months ago.

Jim

Oh, and I forgot.... that D you are taking? Is it the RX one?

If so that is D2 and doesn't work. You'll need to be on D3 OTC at 1000IU for every 10 pts you need to raise. You will need to know your D test results also.

Hi,

Sorry that I haven't posted to this thread lately, but I found the neurologist's report (in prep for an appointment tomorrow with a physiatrist).

Vitamin D, 25-Hydroxy: 13.2 ng/mL

Vitamin B12: 549 pg/mL


Also, here're his findings from the EMG and NCV (done in May 2012):

Nerve Conduction Studies:

The right peroneal and tibial motor potentials reveal borderline low amplitude, with normal distal latency, and conduction velocity.

The left tibial motor potentials reveal normal distal latency, amplitude, and conduction velocity.

F-wave latencies are normal in the right peroneal and tibial nerves.

The right superficial peroneal sensory potentials are absent.

The right sural sensory potentials reveal normal onset latency, low amplitude, and normal conduction velocity.

The left sural sensory potentials reveal normal onset latency, amplitude, and conduction velocity.


Needle EMG:

Testing of selected muscles of the right leg with monopolar needle reveals no spontaneous activity such as positive sharp waves, fibrillation potentials,, or fasciculations in the tibialis anterior, gastrocnemius, vastus medialis, EHL, or FDL muscles.

The motor unit potentials reveal large, polyphasic configuration in the tibialis anterior and EHL muscles with reduced recruitment pattern.


Conclusions:

There is electrophysiological evidence of a sensorimotor peripheral neuropathy, with predominant axonal features, mainly affecting the sensory fibers and the right leg.

Needle EMG testing reveals no acute denervation, BUT there are chronic neurogenic changes in distal muscles, which correlates with axonal, length dependent involvement.

Reinnervation changes of the L5 myotome can also be associated with chronic L5 radiculopathy.


Can anyone interpret/comment on the above in English? I'm especially wondering about that last sentence ("Reinnervation..."), vis-a-vis I showed the above EMG/NCV info to my original neurosurgeon, and he said that there were no problems with my back/spine?

Thanks,
Jim

Well, your D is very very low. When it gets this low, you cannot absorb calcium well, and then the muscles get strange and you can have paresthesias. If this is not fixed your body will rob your bones and eventually you will get osteoporosis.

You should be on OTC D3 at 1000IU for every 10 pts you need to increase. For you to get to the new lowest "normal" of 50, you'd need 4,000IU daily. If you are heavy or large you may need a bit more. Do this for 3 months, and then get retested to see how your level has changed and how you feel.

The B12 is just above the lowest normal...for people with neuro symptoms, it is suggested to take B12 anyway (Dr. Snow suggests this in his medical paper), since it is non-toxic. We here like to keep our B12 at 1000 or more for best results.

Axons are the long parts of nerves that travel distances to the spine. They enervate muscles mostly but some pain signals also. When damaged by inflammation or autoimmune attack, or toxins, they may repair if B12, folate, B6 and Omega-3s are present to rebuild the myelin. Some drugs block remyelination, like statins for cholesterol. So it might be that reinervation is similar. Length dependent PN is a damage to the axons.

Let's see what Glenn thinks.
Since you are showing axonal damage, you might consider Acetyl Carnitine, as a supplement. Start at 500mg a day (divide doses 250mg twice a day) and work up by 500mg a week to 2 grams. Do this for a month or two and see if there is any improvement.

Methylcobalamin B12 1000mcg or 5000mcg a day on an empty stomach, to bring you up a little. 5000 would be faster, and can be lowered to 1000 later if you choose.

Fish oil 3 a day with food. Or 2 reg. Krill oil a day with food.
Multivitamin for the rest (without iron if you are male or postmenopausal female).

Vit D3 4,000 IU daily.

See what happens or changes.

Hi,

I just got back from my appointment with the new physiatrist. Surprising, he spent quite a lot of time with me, going through all of the information, including my past MRIs, two EMGs that I had done, etc. He said the latest EMG, where the neurologist had diagnosed idiopathic peripheral neuropathy was suspect.

He offered that he could do another EMG, which I might go ahead with, but he said that with all the info he'd seen, he felt that the numbness, etc. was probably due to spinal problems that didn't get taken care of by the minimally invasive laminectomy that I had undergone in 2010.

He also said that we could try an epidural, but with a different practitioner, but I'm not sure if I'm going to go forward with that.

Jim